Provider Demographics
NPI:1861714537
Name:BUSH, ALLYSON NORWOOD (LCPC)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NORWOOD
Last Name:BUSH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4925
Mailing Address - Country:US
Mailing Address - Phone:406-212-7576
Mailing Address - Fax:
Practice Address - Street 1:723 5TH AVE E # 10C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5321
Practice Address - Country:US
Practice Address - Phone:406-212-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1482101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid
MT1861714537Medicaid